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Your name, home, work, & cell phone:  

Address, city, state & zip: 

Email:

Your vet’s name:

Your vet's address, city, state, zip & phone:

Emergency contact name & number :

Dog’s name, breed, & age:

Dog’s birthday: Is your dog on any medications?yes no

What brand of dog food do you use?

Has your dog been spayed or neutered?yes no

Has your dog been micro-chipped?yes no

Does your dog have any restrictions on his/her movement or physical

activities, please explain:

Does your dog have any sensitive areas?yes no- if so where?

Does your dog like being brushed?yes no

What kind of collar do you use?

Do you use an invisible fence?yes no

Does your dog sit when asked to?yes no

Does your dog come when called?yes no

What other commands does your dog know?

Has your dog ever been to daycare ? yes no

How often does your dog play with other dogs?

Where did you get your dog?

Does your dog like children?yes no

Does your dog like puppies?yes no

Has your dog ever shown any problems with chewing, barking, house training,

etc? yes no-if so, please explain:

Has your dog ever shown aggression towards another animal or human and if so,

please explainyes no

Is your dog food possessive?yes no

Is your dog toy possessive?yes no

Has your dog had any sort of training?If so what and with whom?

How does your dog react when strangers enter your yard?

If adopted, what knowledge do you have of your dog’s history?

Is there anything else you would like us to know about your dog?

How did you hear about us? ( google, print ad, word-of-mouth,etc.?)

Please complete all fields.